Latissimus Dorsi reconstruction.
The large muscle covering the most of your upper back is called Latissimus Dorsi (LD) and can be used to reconstruct a breast, especially if you have had radiotherapy as it brings with it new skin and bloodsupply. You will not miss the function of the muscle.
There are two types of LD reconstructions: in a standard reconstruction most of the muscle and a small area of skin is taken from your back and swung around to the chest, in an extended LD the whole muscle and as much fat from the back is taken as well, apart from a small skin paddle. There are two main differences: the bulk provided and how the back looks: In a standard LD reconstruction the volume of the new breast is often supplemented with an implant, whilst it may not be necessary in an extended LD, depending on the size of the breast on the other side. In a standard LD the back is almost symmetrical, but in an extended LD reconstruction the side the muscle and fat is taken from is often much slimmer than the opposite side. This can be equalised by liposuction and removal of skin if necessary.
The scars on the back from an LD reconstruction can either be horizontal and hidden under the closure of the bra at the back, or oblique and therefore hidden in a lowcut dress. The scars on the new breast are situated under the breast and above it. If you have had a skin sparing mastectomy the scars may even be limited to the nipple itself. Remember the scars take a year to settle and if you are worried about keloid or bad scarring you should discuss this carefully with Barbara Jemec.
Why should I have a LD reconstruction?
If you have had radiotherapy as part of your treatment for breastcancer, you may have noticed that the skin on your chest is perhaps a little darker thank the surrounding skin and not as soft as elsewhere. This skin is not really suitable for an implant only reconstruction, but need imported skin, for instance from the back.
What happens to the muscle once it is on my chest?
Because it is not used as before it slowly becomes thinner. If the nerve to the muscle is left intact, the muscle remains bulkier, but also moves when you use the muscle. That is why one can cut the nerve supplying the muscle, which will stop it moving.
The operation lasts about 4 hours (other options using your own tissues are longer, apart from a pedicled TRAM) and it takes 6 weeks to recover.
You will have at least two drains at the back and two at the front and prepare to stay for a week in hospital. This operation is very safe and very few flaps fail. The new breast needs time to settle, before maximal symmetry is achieved, this make take up to a year.
Bad scars
Asymmetry (back and front)
Capsule formation if an implant is used
A bleed under the flap or the back which needs removing in theatres
A collection of fluid (seroma) under the skin of the back which needs repeated draining (probably the most common complication)
Flap failure (very very rare)
Deep Vein Thrombosis (DVT)
Pulmonary Embolus (potentially fatal)
contact 0207 483 5090 or 07578 876 549 for consultations
any inquiries please email: plasticsurgeryjemec@gmail.com